Journal article
Use of Main Renal Artery Clamping Predominates Over Minimal Clamping Techniques During Robotic Partial Nephrectomy for Complex Tumors
Journal of endourology, Vol.31(2), pp.149-152
02/2017
DOI: 10.1089/end.2016.0678
PMID: 27936928
Abstract
Hilar clamping is often performed to facilitate robotic partial nephrectomy (RPN). Minimal clamping techniques may reduce renal ischemia, including early unclamping, selective clamping, and off-clamp RPN. We assess the utilization of clamping techniques in a large international consortium of surgeons performing RPN for complex tumors.
We retrospectively evaluated 721 patients with complex tumors, who underwent RPN at 11 centers worldwide between 2008 and 2014. Complex tumors were defined as renal masses with a nephrometry score >6. Total clamping was defined as complete clamping of the main renal artery. Minimal clamping techniques included early unclamping, selective clamping, and off-clamp RPN. Clamping techniques were additionally assessed in patients with estimated glomerular filtration rate (eGFR) <60 and in patients with a solitary kidney. Two-tailed t-tests (p < 0.05) were used to statistically analyze differences in mean warm ischemia time (WIT).
Most patients underwent complete clamping (75.1%). Minimal clamping (24.9%) included early unclamping (10.8%), selective clamping (8.7%), and off-clamp (5.4%). Mean WIT of total clamping, selective clamping, and early unclamping was 22.2, 21.2, and 17.3 minutes, respectively. Of patients with an eGFR <60 (n = 90), 26.6% underwent minimal clamping, including 15.5% early unclamping, 4.4% selective clamping, and 6.7% off-clamp. Of patients with solitary kidneys (n = 12), 10 (83%) were performed with total clamping with mean WIT of 14.9 minutes.
In this large international series of RPN for complex tumors, most patients underwent total clamping of the main renal artery. Minimal clamping techniques, including early unclamping, selective clamping, and off-clamp techniques, were used in a minority of cases. There was no significant increase in use of minimal clamping, even in patients with chronic kidney disease or solitary kidneys. However, mean WIT was low (<23 minutes) in all patient groups.
Details
- Title: Subtitle
- Use of Main Renal Artery Clamping Predominates Over Minimal Clamping Techniques During Robotic Partial Nephrectomy for Complex Tumors
- Creators
- Leedor Lieberman - Wayne State UniversityRavi Barod - Henry Ford HospitalDeepansh Dalela - Henry Ford HospitalMireya Diaz-Insua - Henry Ford HospitalRonney Abaza - Methodist HospitalJames Adshead - Lister HospitalRajesh Ahlawat - Medanta The MedicityBenjamin Challacombe - King's College LondonProkar Dasgupta - King's College LondonGiogio Gandaglia - 7 OLV Vattikuti Robotic Surgery Institute , Melle, BelgiumDaniel A Moon - Peter MacCallum Cancer CentreGiacomo Novara - University of PaduaFrancesco Porpiglia - Ospedale San Luigi GonzagaAlexandre Mottrie - 7 OLV Vattikuti Robotic Surgery Institute , Melle, BelgiumMahendra Bhandari - Henry Ford HospitalCraig Rogers - Henry Ford Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.31(2), pp.149-152
- DOI
- 10.1089/end.2016.0678
- PMID
- 27936928
- NLM abbreviation
- J Endourol
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Language
- English
- Date published
- 02/2017
- Academic Unit
- Urology
- Record Identifier
- 9984949201802771
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